Provider Demographics
NPI:1508384447
Name:RUIZ, MARIANA ELISSA
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:ELISSA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W 26TH ST RM 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6803
Mailing Address - Country:US
Mailing Address - Phone:212-604-9360
Mailing Address - Fax:212-604-9361
Practice Address - Street 1:134 W 26TH ST RM 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6803
Practice Address - Country:US
Practice Address - Phone:212-604-9360
Practice Address - Fax:212-604-9361
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist